Prior to this, family and community cared for mentally ill (or left to care for self)

Creation of large hospitals ? unexpected social problem committing people for reasons other than mental disorders (e.g., political beliefs)

3A. Mental Illness

Mental illness a legal concept referring to severe emotional or thought disturbance that negatively affects an individuals health and safety

Legal term ? every state has its own definition

Many states exclude mental retardation and substance use disorders from the definition

4B. Criteria for Civil Commitment

Rules vary by state

Historically, person could be committed when one of the following conditions was met

Person has a mental illness and is in need of treatment

Person is dangerous to himself or others

Person is unable to care for himself (grave disability)

5B. Criteria for Civil Commitment (cont.)

Commitment process

petition by relative or mental health professional to a judge

Judge orders evaluation

Hearing held in court (protects patients rights)

Judge or jury (depending on state law) can hear and decide commitment case

6B. Criteria for Civil Commitment (cont.)

Commitment process is similar to a trial

Must notify person of the proceedings

Person must be present at the hearing

Person must be given legal representation

Person can examine witnesses

7B. Criteria for Civil Commitment (cont.)

In an emergency (person is a danger to self/others), temporary commitment can be made without a hearing 72-hour hold

Longer commitment term would require a formal hearing

8C. Special Cases of Civil Commitment

Many states (e.g., FL) have adopted special cases of civil commitment

Sexual predator laws are civil commitment laws

Allow for civil commitment of criminals who have served their prison term for a sexual offense

Commitment is until the offender is deemed no longer a threat to others (which may be never)

9A few questions

What is the purpose of civil commitment for society?

What is the purpose of civil commitment for the person who is committed?

10D. Deinstitutionalization

Recalldeinstitutionalization movement of people with severe mental illness out of institutions

Goals

Decrease number of people in state hospitals to reduce number of state hospitals

Accomplished large reduction in number of state hospitals by 1980s

11Goals (cont.)

Provide community care for mentally ill

Failed community care did not materialize for majority of patients removed from institutions

Transinstitutionalization moving people from mental hospitals to other types of institutions (jails, nursing homes)

Care for mentally ill marginal

12D. Deinstitutionalization (cont.)

Resulted in increased homelessness

But, not all homeless are mentally ill

20-30 of homeless have a history of psychological problems/disorder

13Legal and Ethical Issues

II. Criminal Commitment

14A. Criteria for Criminal Commitment

Criminal commitment laws vary by state

Most states hold people in prison or mental hospitals under either of two conditions

Person has been accused of a crime and must be assessed for fitness to stand trial

Pre-trial, but not necessarily a brief period of time

Must demonstrate competency to stand trial be able to understand proceedings and participate in the defense

Burden of proof is on the defense to show competency

Law prohibits indefinite commitment, but language of law usually gives judges ability to commit for years

15Commitment conditions (cont.)

Person found not guilty by reason of insanity

Rare ? less than 1 of felony cases use insanity defense

26 of those result in a not guilty by reason of insanity verdict

15 of those are set free without any period of criminal commitment

16B. Duty to Warn

Tarasoff vs. Regents of the University of California (1974, 1976)

basis of duty to warn rule

Graduate student (paranoid Sz) indicated to 2 therapists at the university his intention to kill Tatiana Tarasoff (fellow student)

Therapists called police ? investigated, got assurances that he would not harm Tarasoff

Shot and stabbed Tarasoff a few weeks later

Her parents sued said someone should have warned Tarasoff of the danger

Therapists must now warn a person against whom a patient has made a serious threat

17Legal and Ethical Issues

III. Ethical Treatment in Practice and Research

18A. APA Ethics Code

American Psychological Association (APA) provides ethics code for members

Psychological research

Therapy

Several (e.g., do not have sex with clients)

General

Several for example

Do not hold multiple relationships if they will impact objectivity, effectiveness, or competence

Confidentiality limits legal limits such as duty to warn

19Summary

Civil commitment mental illness danger to self/others

Deinstitutionalization

Criminal commitment competency not guilty by reason of insanity

Duty to warn

APA ethics code

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